永田小耳症形成外科クリニックと愉快な仲間たち

愉快な仲間たちの秘密の会話

Nagata Microtia and Reconstructive Plastic Surgery Clinic
Satoru Nagata.M.D.Ph.,D.   14/June/2012
1st-stage operation for lobule type microtia

永田小耳症形成外科クリニック・ 永田 悟・ 2012年7月14日
耳垂残存型小耳症の肋軟骨移植術


P1040881.jpg
The preoperative appearance of the lobule type microtia.

耳垂残存型小耳症の術前。

P1040882.jpg
Determine the proper anatomical location
during the first stage operation
with the film template.

解剖学的に正常な耳の場所を決定するために
透明フイルムに印刷した設計図を用いる。

P1040883.jpg
The actual outline for the reconstruction of the auricle
and anterior surface of the lobule.

耳垂前面の切開線。

P1040884.jpg
W-shaped incision
on the posterior surface of the lobule
and the mastoid surface.
Note that the line of the mastoid surface
extends 4mm beyond the outline
of the auricle to be reconstructed.

耳垂後面から乳突洞部にかけてのW型切開線。

P1040885.jpg
The fabricated 3 dimensional costal cartilage frame
[3-D frame] with the paper template.

作成した3次元肋軟骨フレームと紙型。

P1040886.jpg
The intraoperative appearance
with the skin flaps formed
[tragus skin flap,
posterior and anterior skin flap of the lobule
and the mastoid skin flap].

4枚の皮弁形成および皮下ポケットの作成。

P1040887.jpg
Immediately after the first stage operation
prior to Bolster sutures.
Note that the excess skin in the anterior region
of the helical rim is excised
during the first stage operation.

皮下ポケットに3次元肋軟骨フレームを移植した。

P1040888.jpg
The actual appearance
at the end of the first stage operation
with Bolster sutures.
Suction drains are not used because, with my method,
unlike the Tanzer or Brent method
 where skin surface area is insufficient,
there is ample and sufficient skin surface area
to cover the 3-D frame.
Therefore it is possible to use the Bolster sutures
without the worry of necrosis.
Furthermore, the nurses do not have to change
the vacutainers on an hourly or bi-hourly basis
and the patients are not troubled with the change.

ボルスター縫合固定を行った。












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